The Alliance for Home Dialysis has released an updated analysis by Avalere Health on the distribution of dialysis patients using home modalities in the United States. The analysis is based on “heat maps” that break down the location of peritoneal dialysis and home hemodialysis patients by state using 2011 Medicare data. The maps also show utilization of home modalities by race and a breakdown by End-Stage Renal Disease Networks. The patient numbers by state also include patients in nursing homes.

PD patients

According to the Alliance, PD and HHD use varied widely by race and state. Nationally, 8.8% of dialysis patients received peritoneal dialysis (PD) in 2011. This percentage varies by race from 10.6% for white dialysis patients to 7.9% for Hispanic dialysis patients and 6.3% for black dialysis patients. PD utilization also varies widely by state, from 3.7% of dialysis patients in the District of Columbia to 25.6% of dialysis patients in Alaska. By race and state, PD patients account for 4.7% of white dialysis patients in Rhode Island vs. 27.5% on PD in Alaska, according to the Avalere Health study. For blacks, there are no patients on PD in three states but 36.4% on PD in Idaho. Among Asian dialysis patients, there are none on PD in nine states but 29.4% are on PD in Arkansas. For Hispanic dialysis patients, there are none on PD in three states to as high as 40% of the general dialysis population in Maine. Nationally, black dialysis patients are approximately 29% less likely than average to be receiving PD and Hispanic dialysis patients are approximately 10% less likely than average to be receiving PD.

HHD patients

For home hemodialysis, utilization again varies widely by race and state. Nationally, 2.7% of dialysis patients received home hemodialysis (HHD) in 2011. This percentage varies by race from 3.3% for white dialysis patients to 2.2% for black or Asian dialysis patients and 1.7% for Hispanic dialysis patients. HHD utilization also varies widely by state, from 0.2% of dialysis patients in Rhode Island to 10.9% of dialysis patients in Illinois. By race and state, there are no whites on HHD in the District of Columbia but 12.4% of the dialysis population is on HHD in Illinois. There are no black dialysis patients on HHD in eight states, but 9.1% on HHD in Illinois. There are no Asian dialysis patients on HHD in 18 states, but 25% on HHD in West Virginia. There are no Hispanic dialysis patients in 12 states but 25% on HHD in West Virginia. Nationally, black dialysis patients are approximately 20% less likely than average to be receiving HHD and Hispanic dialysis patients are approximately 37% less likely than average to be receiving HHD.

For more information on the analysis, go to www.homedialysisalliance.org